Albumin and Derived Neutrophil-to-Lymphocyte Ratio is a Novel Prognostic Factor for Patients with Esophageal Squamous Cell Carcinoma

Background Multidisciplinary treatment combining neoadjuvant treatment (NAT) and surgery has slightly improved the prognosis of patients with esophageal squamous cell carcinoma (ESCC). Although various biomarkers targeting nutrition and inflammation are associated with cancer prognosis, most studies have focused on conditions prior to NAT. Developing real-time and sensitive biomarkers that monitor changes in systemic conditions during NAT is important. We established a novel nutritional and inflammatory index, represented as the albumin to derived neutrophil-to-lymphocyte ratio (Alb-dNLR), and calculated the change in Alb-dNLR (Delta Alb-dNLR) during neoadjuvant chemotherapy (nCT). In this study, we aimed to evaluate whether Delta Alb-dNLR is associated with prognosis in patients with ESCC. Methods We investigated 172 patients who underwent nCT before esophagectomy between April 2010 and March 2018. The dNLR was calculated as the ratio of neutrophil count to (white blood cell count - neutrophil count), Alb-dNLR was calculated by dividing the serum albumin level by the dNLR, and Delta Alb-dNLR was evaluated by dividing the post-Alb-dNLR by the pre-Alb-dNLR. Patients were divided into 'high' and 'low' groups according to the Delta Alb-dNLR. Results Thirty-nine patients (22.7%) had a low Delta Alb-dNLR (<= 0.8), and the 5-year overall survival (OS) rates in patients with low and high Delta Alb-dNLR were 38.1% and 53.6%, respectively (p = 0.0072). Multivariate analyses demonstrated that estimated blood loss (p = 0.044), pathological T stage (p = 0.0005), pathological N stage (p = 0.017), and Delta Alb-dNLR (p = 0.005) were independent prognostic factors for OS. Conclusions Delta Alb-dNLR is a useful prognostic factor for OS in patients with ESCC receiving nCT.